Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 186
Filtrar
1.
Nat Med ; 25(7): 1037-1044, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31270501

RESUMO

The process of developing new and complex stem-cell-based therapeutics is incremental and requires decades of sustained collaboration among different stakeholders. In this Perspective, we address key ethical and policy challenges confronting the clinical translation of stem-cell-based interventions (SCBIs), including premature diffusion of SCBIs to clinical practice, assessment of risk in trials, obtaining valid informed consent for research participants, balanced and complete scientific reporting and public communications, regulation, and equitable access to treatment. We propose a way forward for translating these therapies with the above challenges in mind.


Assuntos
Transplante de Células-Tronco/ética , Ensaios Clínicos como Assunto , Ética em Pesquisa , Custos de Cuidados de Saúde , Humanos , Consentimento Livre e Esclarecido , Estudos Prospectivos , Transplante de Células-Tronco/economia , Transplante de Células-Tronco/legislação & jurisprudência
3.
Biotechnol J ; 14(8): e1800563, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31127682

RESUMO

Differentiation of pluripotent stem cells (PSCs) into ß cells could provide insulin independence for type 1 diabetes (T1D) patients. This approach would reduce the clinical complications that most patients managed on intensive insulin therapy (IIT) face. However, bottlenecks of PSC manufacturing and limited engraftment of encapsulated cells hinder the long-term effectiveness of these therapies. A bioprocess decision-support tool is combined with a disease state-transition model to evaluate the cost-effectiveness of the stem cell-based therapy against IIT. Clinical effectiveness is assessed in quality-adjusted life years (QALYs). Manufacturing costs per patient reduce from $430 000 to $160 000 with optimization of batch size and annual demand. For 96% of the patients, cell therapy improves the quality of life compared to IIT. Cost savings are achieved for 2% of the population through prevention of renal disease. The therapy is cost-effective for 3.4% of patients when a willingness to pay (WTP) of up to $150 000 per QALY is considered. A 75% cost reduction in the cell therapy price increases cost-effectiveness likelihood to 51% at $100 000 per QALY. This study highlights the need for scalable manufacturing platforms for stem cell therapies, as well as to prioritizing access to the therapy to patients with an increased likelihood of costly complications.


Assuntos
Biotecnologia/economia , Terapia Baseada em Transplante de Células e Tecidos/métodos , Diabetes Mellitus Tipo 1/terapia , Biotecnologia/métodos , Terapia Baseada em Transplante de Células e Tecidos/economia , Terapia Baseada em Transplante de Células e Tecidos/instrumentação , Análise Custo-Benefício , Meios de Cultura/economia , Diabetes Mellitus Tipo 1/economia , Humanos , Células-Tronco Pluripotentes , Qualidade de Vida , Transplante de Células-Tronco/economia , Transplante de Células-Tronco/instrumentação , Transplante de Células-Tronco/métodos
4.
Eur J Cancer Care (Engl) ; 28(4): e13026, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30828907

RESUMO

OBJECTIVE: We provide a real-world overview of multiple myeloma (MM) treatment patterns, outcomes and healthcare resource use (HRU) in Portugal. METHODS: Data were collected retrospectively from consecutive patients diagnosed/treated at the Portuguese Oncology Institute of Porto (IPO-Porto) between 2012 and 2015. Primary objectives were progression-free survival (PFS) and overall survival (OS), with treatment patterns and HRU secondary. Analysis was by line of therapy (LOT), and post hoc by age (<65/≥65 years). RESULTS: 165, 73 and 32 patients received first, second and third LOTs respectively (N = 187). OS probabilities were 91.5%, 83.2% (<65 years) and 86.6%, 65.3% (≥65 years) at 12, 24 months respectively. PFS decreased from the start of each LOT for both age groups and was less for patients ≥65 years. Younger patients received more combination treatment (immunomodulatory drugs + proteasome inhibitors) and stem cell transplants, and had higher mean costs than older patients (€81,213 vs. €36,864 where three LOTs were received). Cost drivers were medications, transplantations and hospitalisations. CONCLUSION: Our results suggest divergence between younger and older MM patients. Older patients had lower OS and PFS probabilities, HRU costs and fewer stem cell transplantations. The treatment patterns in each LOT may differ from other countries' findings, suggesting treatment heterogeneity.


Assuntos
Antineoplásicos/uso terapêutico , Custos de Cuidados de Saúde , Fatores Imunológicos/uso terapêutico , Mieloma Múltiplo/terapia , Padrões de Prática Médica , Inibidores de Proteassoma/uso terapêutico , Transplante de Células-Tronco/estatística & dados numéricos , Fatores Etários , Idoso , Antineoplásicos/economia , Compostos de Boro/economia , Compostos de Boro/uso terapêutico , Bortezomib/economia , Bortezomib/uso terapêutico , Custos de Medicamentos/estatística & dados numéricos , Feminino , Glicina/análogos & derivados , Glicina/economia , Glicina/uso terapêutico , Recursos em Saúde/economia , Hospitalização/economia , Humanos , Fatores Imunológicos/economia , Lenalidomida/economia , Lenalidomida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/economia , Portugal , Intervalo Livre de Progressão , Inibidores de Proteassoma/economia , Transplante de Células-Tronco/economia , Taxa de Sobrevida , Talidomida/economia , Talidomida/uso terapêutico
5.
Orphanet J Rare Dis ; 14(1): 48, 2019 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-30777108

RESUMO

BACKGROUND: Severe mucopolysaccharidosis type I (also known as Hurler syndrome) is a rare devasting recessive genetic disease caused by the deficiency of an enzyme. Hematopoietic stem cell transplant is the standard of care in the United States, usually conducted before the child is 3 years of age, but little is known about the continued medical and educational needs of the child after transplant. A greater understanding of the burden of illness on the primary caregiver is also needed. Therefore, this online survey sought to gather information on the burden of severe MPS I in the United States at least 1 year after transplant. RESULTS: Thirty-two respondents reported that children with severe MPS I have significant medical and educational needs after transplant. Healthcare resource use was frequent, especially in the outpatient setting specifically for bone, cardiac, and vision complications that were not relieved by HSCT. Twenty-five percent of the children had been hospitalized at least once in the last year and two had been hospitalized twice. The most common reasons for overnight hospitalizations included orthopedic surgeries and respiratory infections. Among children ages 5 and older, only 3 of 28 (11%) were able to attend school with no special support. While caregivers were generally satisfied with the healthcare services their child receives, 69% of working caregivers reported negative impact on their ability to conduct work tasks, and 54% of caregivers did not work so that they could care for the child. CONCLUSIONS: Results suggest that severe MPS I children continue to  require medical care and special support for education. Future research on the burden of illness on families affected by severe MPS I is needed to better understand total cost of care, and to identify therapies and interventions that reduce burden of illness. Future studies that compare cost of and access to health care in different countries may provide a more global view of the burden of MPS I.


Assuntos
Mucopolissacaridose I/economia , Adolescente , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , Humanos , Internet , Masculino , Transplante de Células-Tronco/economia , Inquéritos e Questionários , Estados Unidos
6.
Value Health ; 22(2): 254-262, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30711072

RESUMO

OBJECTIVES: To examine economic evaluation studies of stem cell therapies (SCTs) in neurological disorders and to provide an overview of the quality of the economic evidence available on this topic. METHODS: The review examined studies that performed an economic evaluation of the use of stem cells in adult patients with neurological diseases and that were published in English during the period 2007 to 2017. Data analyzed and reported included study population, disease indication, main analytical approaches for the economic analysis and perspective, key assumptions made or tested in sensitivity analyses, cost outcomes, estimates of incremental cost effectiveness, and approaches to quantifying decision uncertainty. RESULTS: A total of three studies reporting on the findings of the economic evaluation of the use of SCT in stroke, Parkinson disease, and secondary progressive multiple sclerosis, respectively, were identified. All three studies conducted a cost-utility analysis using decision-analytic models and reported an incremental cost per quality-adjusted life-years gained (incremental cost-effectiveness ratio) versus standard care. These studies reported meaningful cost savings in stroke, Parkinson disease, and secondary progressive multiple sclerosis in the base-case scenarios. CONCLUSIONS: Despite significant progress in clinical research in the use of SCT in neurological diseases, economic evaluation of these therapies is still at a nascent stage. Given the early stage of research inputs (clinical and cost outcomes data) into the models per se, further research is urgently needed to enable meaningful assessment of the cost effectiveness of these advanced therapies and to ensure sustainable access for population groups most likely to benefit in clinical practice.


Assuntos
Análise Custo-Benefício/métodos , Doenças do Sistema Nervoso/economia , Doenças do Sistema Nervoso/terapia , Transplante de Células-Tronco/economia , Humanos , Doenças do Sistema Nervoso/epidemiologia , Transplante de Células-Tronco/métodos , Avaliação da Tecnologia Biomédica/economia , Avaliação da Tecnologia Biomédica/métodos
7.
J Am Acad Orthop Surg ; 27(20): 779-783, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30499895

RESUMO

INTRODUCTION: The use of stem cell therapy (SCT) and platelet-rich plasma (PRP) injection for knee osteoarthritis (OA) is extremely controversial and at best experimental stage. These treatments are being offered across the nation for "cash-only payments." Our objectives were to determine (1) what proportion of board-certified orthopedic surgeons in Miami-Dade County offer SCT or PRP and (2) how much do practices charge for these services. METHODS: All board-certified orthopedic surgeons' offices in Miami-Dade County were identified by their American Academy of Orthopaedic Surgeons active membership. Offices were contacted and presented a hypothetical patient with end-stage OA searching for treatment (SCT or PRP injections) before having to undergo surgery. RESULTS: Of the 96 registered American Academy of Orthopaedic Surgeons member's offices, 91 (94.7%) were contacted, 36% of offices offered PRP, and 24.5% offered SCT. However, 81% of the offices were transparent on the pricing of PRP, whereas 42% gave a price for SCT. Remaining practices stated that pricing would be "determined or discussed" during a scheduled visit. Mean cost for PRP injection was $897 (range, $350 to $1,700), and for SCT injection, it was $3,100 (range, $1,200 to $6,000). DISCUSSION: Biological injectables as treatment of knee OA have potential use in the nonsurgical management of this disease. Data on the effectiveness are lacking and are conflicting. Data should continue to be investigational. LEVEL OF EVIDENCE: Level IV.


Assuntos
Osteoartrite do Joelho/economia , Osteoartrite do Joelho/terapia , Plasma Rico em Plaquetas , Padrões de Prática Médica/economia , Transplante de Células-Tronco/economia , Florida , Humanos , Injeções Intra-Articulares/economia , Cirurgiões Ortopédicos
9.
Eur J Health Econ ; 20(2): 303-316, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30121870

RESUMO

Informal care is a substantial source of support for people with cancer. However, various studies have predicted its disappearance in the near future. The aim of this study is to analyse the catastrophic effect resulting from the substitution of informal care with formal care in patients with blood cancer throughout the different stages of treatment. A total of 139 haematological neoplasm patients who underwent stem cell transplantation in Spain, completed a longitudinal questionnaire according to the three phases of treatment between 2012 and 2013. The economic value of informal care was estimated using proxy good, opportunity cost, and contingent valuation methods. Catastrophic health expenditure measures with thresholds ranging from 5 to 100% were used to value the financial burden derived from substitution. A total of 88.5% of patients reported having received informal care. In 85.37%, 80.49%, and 33.33% of households, more than 40% of their monthly income would have to be devoted to the replacement with formal care, with monthly amounts of €2105.22, €1790.86, and €1221.94 added to the 40% in the short, medium, and long-term, respectively (proxy good method, value = 9 €/h). Informal caregivers are a structural support for patients with blood cancer, assuming significant care time and societal costs. The substitution of informal care with formal care would be financially unaffordable by the families of people with blood cancer.


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Neoplasias Hematológicas/economia , Assistência ao Paciente/economia , Assistência ao Paciente/métodos , Adolescente , Adulto , Idoso , Cuidadores/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Neoplasias Hematológicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Assistência ao Paciente/estatística & dados numéricos , Espanha , Transplante de Células-Tronco/economia , Inquéritos e Questionários , Adulto Jovem
11.
Regen Med ; 13(4): 375-384, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29985757

RESUMO

AIM: To better understand how prospective customers interpret claims of businesses marketing unproven stem cell products that they are engaging in research activities. MATERIALS & METHODS: The authors examined 408 crowdfunding campaigns for unproven stem cell interventions for references to research activities. RESULTS: The authors identified three overarching themes: research as a signifier of scientific credibility; the experimental nature of stem cells as a rationale for noncoverage by insurers; and contributing to the advancement of science by engaging in research. CONCLUSION: The NIH, US FDA and others should be concerned about being co-opted to misrepresent the nature of these businesses' activities. Efforts are also needed to better inform those considering purchasing unproven stem cell interventions about their relationship to legitimate research.


Assuntos
Transplante de Células-Tronco , Humanos , National Institutes of Health (U.S.) , Transplante de Células-Tronco/economia , Transplante de Células-Tronco/legislação & jurisprudência , Transplante de Células-Tronco/normas , Estados Unidos , United States Food and Drug Administration
12.
Perspect Biol Med ; 61(1): 25-41, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29805146

RESUMO

The direct-to-consumer marketing of stem cells for unproven therapeutic uses has grown rapidly in the United States in recent years. This development is surprising since the marketing and distribution of human cell-based medical products is stringently regulated in the US. This essay describes ambiguities, gaps, and inconsistencies in the current regulatory system that have enabled such businesses to thrive. In addition to directly challenging the authority of the Food and Drug Administration (FDA) over autologous cell-based products in the courts, stem cell marketing firms have also identified and exploited regulatory loopholes, such as the same surgical procedure exception, which exempts from FDA oversight human cell-based products that are harvested and reimplanted in a single procedure. Many businesses also advertise stem cell clinical studies on a pay-to-participate basis, which requires patients to pay large sums to enroll in clinical research. This business model not only shifts many of the cost and risks of medical experimentation from providers to patients but may also indemnify sellers from fraud litigation. Lastly, stem cell advertisers borrow heavily from the language and concepts of science-based medicine in their marketing. The inaccurate promotion of autologous stem cell injections as a form of "personalized" medicine lends a veneer of credibility and precision that may encourage patients to undergo procedures of uncertain effectiveness and to sympathize with stem cell businesses in their efforts to evade oversight.


Assuntos
Marketing/métodos , Transplante de Células-Tronco/legislação & jurisprudência , Transplante Autólogo/legislação & jurisprudência , Ensaios Clínicos como Assunto/economia , Ensaios Clínicos como Assunto/ética , Governo Federal , Humanos , Marketing/ética , Participação do Paciente/economia , Medicina de Precisão , Transplante de Células-Tronco/economia , Transplante de Células-Tronco/ética , Transplante Autólogo/economia , Transplante Autólogo/ética , Estados Unidos , United States Food and Drug Administration
13.
Perspect Biol Med ; 61(1): 59-75, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29805148

RESUMO

Demands from patients, health-care professionals, and industry to streamline the market approval process for promising new therapies has prompted the introduction of programs that can provide more rapid access to stem cell-based products before evidence of safety and efficacy has been demonstrated in clinical trials. These products may be approved for marketing under "conditional authorizations," while uncertainty around safety and efficacy is reduced through the collection of clinical data in observational trials or registries. The rationale for conditional approval programs assumes that patients with unmet medical needs will benefit with rapid access to novel stem cell therapies. It also assumes that data gathered in actual clinical contexts is inherently better at reducing uncertainty than conventional clinical trial methods of demonstrating safety and efficacy. These assumptions may be overly optimistic and do not account for the broader societal burdens of prematurely releasing high-cost therapies with uncertain safety risks and benefits on to health-care markets. This essay focuses on the introduction of conditional approval programs for autologous somatic stem cell therapies and argues that these programs may conflict with, and potentially undermine, the normative commitments of regulatory agencies charged with promoting population health and protecting vulnerable groups from harm and exploitation. It concludes with suggestions of how programs designed to accelerate access to potentially helpful but experimental interventions could be reconfigured to be more equitable.


Assuntos
Transplante de Células-Tronco/ética , Transplante Autólogo/ética , União Europeia , Humanos , Agências Internacionais , Japão , Participação do Paciente , Justiça Social , Transplante de Células-Tronco/economia , Transplante Autólogo/economia
14.
Perspect Biol Med ; 61(1): 76-89, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29805149

RESUMO

Australia has a booming market of unproven autologous stem cell- based interventions (SCBIs) for a wide range of medical conditions. Multiple SCBIs are provided in private practices outside of formal clinical trials. Some defend the provision of unproven SCBIs on grounds of patient choice. This essay interrogates this argument for patient choice and explores patients' vulnerabilities in clinical practice with autologous SCBIs. While all patients are inherently vulnerable, the regulatory framework for autologous stem cells in Australia exacerbates the problems associated with inherent vulnerabilities and generates situational and pathogenic vulnerabilities. A just state ought to implement regulatory measures that mitigate vulnerabilities and foster patients' autonomy.


Assuntos
Transplante de Células-Tronco/ética , Transplante Autólogo/ética , Austrália , Humanos , Preferência do Paciente , Relações Médico-Paciente , Transplante de Células-Tronco/economia , Transplante de Células-Tronco/legislação & jurisprudência , Transplante Autólogo/economia , Transplante Autólogo/legislação & jurisprudência
16.
BMJ Open ; 8(2): e019414, 2018 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-29490963

RESUMO

OBJECTIVE: To identify the frequency and qualitative characteristics of stem cell-related marketing claims made on websites of clinics featuring common types of complementary and alternative medicine practitioners. The involvement of complementary and alternative medicine practitioners in the marketing of stem cell therapies and stem cell-related interventions is understudied. This research explores the extent to which they are involved and collaborate with medical professionals. This knowledge will help with identifying and evaluating potential policy responses to this growing market. DESIGN: Systematic website analysis. SETTING: Global. US and English-language bias due to methodology. MAIN OUTCOME MEASURES: Representations made on clinic websites in relation to practitioner types, stem cell therapies and their targets, stem cell-related interventions. Statements about stem cell therapies relating to evidence of inefficacy, limited evidence of efficacy, general procedural risks, risks specific to the mode of therapy, regulatory status, experimental or unproven nature of therapy. Use of hype language (eg, language that exaggerates potential benefits). RESULTS: 243 websites offered stem cell therapies. Many websites advertised stem cell transplantation from multiple sources, such as adipose-derived (112), bone marrow-derived (100), blood-derived (28), umbilical cord-derived (26) and others. Plant stem cell-based treatments and products (20) were also advertised. Purposes for and targets of treatment included pain, physical injury, a wide range of diseases and illnesses, cosmetic concerns, non-cosmetic ageing, sexual enhancement and others. Medical doctors (130), chiropractors (53) and naturopaths (44) commonly work in the clinics we found to be offering stem cell therapies. Few clinic websites advertising stem cell therapies included important additional information, including statements about evidence of inefficacy (present on only 12.76% of websites), statements about limited evidence of efficacy (18.93%), statements of general risks (24.69%), statements of risks specific to the mode(s) of therapy (5.76%), statements as to the regulatory status of the therapies (30.86%) and statements that the therapy is experimental or unproven (33.33%). Hype language was noted (31.69%). CONCLUSIONS: Stem cell therapies and related interventions are marketed for a wide breadth of conditions and are being offered by complementary and alternative practitioners, often in conjunction with medical doctors. Consumer protection and truth-in-advertising regulation could play important roles in addressing misleading marketing practices in this area.


Assuntos
Terapias Complementares , Internet , Marketing , Transplante de Células-Tronco/métodos , Instituições de Assistência Ambulatorial , Humanos , Medição de Risco , Transplante de Células-Tronco/economia
17.
Leuk Lymphoma ; 59(10): 2305-2317, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29390932

RESUMO

Predicated on our improved understanding of the disease biology, we have seen remarkable advances in the management of multiple myeloma over the past few years. Recently approved drugs have radically transformed the treatment paradigm and improved survivals of myeloma patients. The progress has necessitated revision of the diagnostic criteria, risk-stratification and response definition. The huge disparities in economy, healthcare infrastructure and access to novel drugs among different Asian countries will hinder the delivery of optimum myeloma care to patients managed in resource-constrained environments. In the light of the tremendous recent changes and evolution in myeloma management, it is timely that the resource-stratified guidelines from the Asian Myeloma Network be revised to provide updated recommendations for Asia physicians practicing under various healthcare reimbursement systems. This review will highlight the most recent advances and our recommendations on how they could be integrated in both resource-abundant and resource-constrained facilities.


Assuntos
Alocação de Recursos para a Atenção à Saúde/normas , Cooperação Internacional , Oncologia/normas , Mieloma Múltiplo/terapia , Recidiva Local de Neoplasia/terapia , Antineoplásicos/economia , Antineoplásicos/uso terapêutico , Ásia , Consenso , Conferências de Consenso como Assunto , Resistencia a Medicamentos Antineoplásicos , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/tendências , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/tendências , Humanos , Oncologia/métodos , Oncologia/tendências , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/economia , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/economia , Guias de Prática Clínica como Assunto , Medição de Risco , Transplante de Células-Tronco/economia , Transplante de Células-Tronco/normas
18.
BMC Endocr Disord ; 18(1): 6, 2018 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-29382312

RESUMO

BACKGROUND: Although current beta cell replacement therapy is effective in stabilizing glycemic control in highly selected patients with refractory type 1 diabetes, many hurdles are inherent to this and other donor-based transplantation methods. One solution could be moving to stem cell-derived transplant tissue. This study investigates a novel stem cell-derived graft and implant technology and explores the circumstances of its cost-effectiveness compared to intensive insulin therapy. METHODS: We used a manufacturing optimization model based on work by Simaria et al. to model cost of the stem cell-based transplant doses and integrated its results into a cost-effectiveness model of diabetes treatments. The disease model simulated marginal differences in clinical effects and costs between the new technology and our comparator intensive insulin therapy. The form of beta cell replacement therapy was as a series of retrievable subcutaneous implant devices which protect the enclosed pancreatic progenitors cells from the immune system. This approach was presumed to be as effective as state of the art islet transplantation, aside from immunosuppression drawbacks. We investigated two different cell culture methods and several production and delivery scenarios. RESULTS: We found the likely range of treatment costs for this form of graft tissue for beta cell replacement therapy. Additionally our results show this technology could be cost-effective compared to intensive insulin therapy, at a willingness-to-pay threshold of $100,000 per quality-adjusted life year. However, results also indicate that mass production has by far the best chance of providing affordable graft tissue, while overall there seems to be considerable room for cost reductions. CONCLUSIONS: Such a technology can improve treatment access and quality of life for patients through increased graft supply and protection. Stem cell-based implants can be a feasible way of treating a wide range of patients with type 1 diabetes.


Assuntos
Análise Custo-Benefício , Diabetes Mellitus Tipo 1/economia , Diabetes Mellitus Tipo 1/terapia , Transplante das Ilhotas Pancreáticas/economia , Transplante de Células-Tronco/economia , Avaliação da Tecnologia Biomédica/métodos , Humanos , Células Secretoras de Insulina/citologia , Transplante das Ilhotas Pancreáticas/métodos , Expectativa de Vida , Anos de Vida Ajustados por Qualidade de Vida , Transplante de Células-Tronco/métodos , Células-Tronco/citologia
19.
J Pediatr Psychol ; 43(4): 434-442, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29048570

RESUMO

Objective: The purpose of this study was to examine the hypothesis that earlier time to psychology consultation would predict lower costs for the initial stem cell transplant (SCT) hospitalization among patients receiving care at a children's hospital. Methods: A retrospective medical record review identified 75 patients (ages 0-32 years) with one or more visits by a licensed clinical psychologist during the initial SCT hospitalization from 2010 to 2014. Demographic and clinical variables were obtained from the electronic medical record and hospitalization costs were obtained from patient billing records. A generalized linear model with a gamma distribution and log link function was used to estimate the relationship between time to psychology consultation and cost for the initial SCT hospitalization while controlling for demographic, clinical, and utilization factors. Results: After controlling for age at SCT, gender, race, insurance status, diagnosis, SCT type, length of stay, and number of psychology visits, earlier time to psychology consultation predicted lower costs for the initial SCT hospitalization (χ2 = 6.83, p = .01). When the effects of covariates were held constant, every day increase in the time to psychology consultation was associated with a 0.3% increase in SCT hospitalization costs (ß = 0.003, SE = 0.001). Conclusions: Results suggest that facilitating consultations with a pediatric psychologist early in the initial SCT hospitalization may reduce costs for patients undergoing SCT at children's hospitals. Future research is needed to determine the optimal timing of psychology consultation and quantify the economic impact of psychological services.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Hospitais Pediátricos/estatística & dados numéricos , Psicologia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Transplante de Células-Tronco/economia , Adolescente , Adulto , Criança , Pré-Escolar , Registros Eletrônicos de Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Adulto Jovem
20.
J Knee Surg ; 31(6): 551-556, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28738432

RESUMO

The use of stem-cell therapies for the treatment of various musculoskeletal conditions, especially knee osteoarthritis (OA), is rapidly expanding, despite only low-level evidence to support its use. Centers offering these therapies are often marketing and charging patients out-of-pocket costs for such services. Therefore, the purpose of this study was to determine the current marketed: (1) prices and (2) clinical efficacy of stem-cell therapies for knee OA. This was a prospective cross-sectional study which queried 317 U.S. centers that offered direct-to-consumer stem-cell therapies for musculoskeletal conditions. A total of 273 of 317 centers were successfully contacted via phone or e-mail, using a simulated 57-year-old male patient with knee OA. Scripted questions were asked by the simulated patient to determine the marketed prices and clinical efficacy. Centers generally reported the proportion of patients who had "good results" or "symptomatic improvement." The mean price of a unilateral (same-day) stem-cell knee injection was $5,156 with a standard deviation of $2,446 (95% confidence interval [CI]: $4,550-5,762, n = 65). The mean proportion of claimed clinical efficacy was 82% with a standard deviation of 9.6% (95% CI: 79.0-85.5%, n = 36). Most American stem-cell centers offer therapies for knee OA. The cost of these therapies averages about $5,000 per injection, and centers claim that 80% of the patients had "good results" or "symptomatic improvement," denoting a gap between what is documented in the published literature and the marketing claims. These findings offer both patients and physicians insight into the current stem-cell market for knee OA. We hope that with this information, providers can more optimally make patients aware of discrepancies between what is being marketed versus the current evidence-based landscape of these therapies for knee OA.


Assuntos
Marketing de Serviços de Saúde/economia , Osteoartrite do Joelho/cirurgia , Transplante de Células-Tronco/economia , Transplante de Células-Tronco/estatística & dados numéricos , Adulto , Comércio , Estudos Transversais , Feminino , Humanos , Masculino , Marketing de Serviços de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Osteoartrite do Joelho/economia , Osteoartrite do Joelho/epidemiologia , Estudos Prospectivos , Resultado do Tratamento , Estados Unidos/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA